CAPRICES OF HUMAN MEMORY

Human memory is a strange thing. On one hand, medicine and science dive deep into the brain’s mechanisms of memory. Psychiatrists will tell you all about long and short term memory and their disorders. Brain scientists will tell you all about neuronal interconnections. Geneticists will be glad to pour onto you breakthroughs in molecular and genetic structures of memory (even if you feel lost after their first two sentences). On the other hand, we do not have a clue as to why human memory is so different from animals. If you carefully watch National Geographic’s movies on TV you would notice that, for example, when a lion runs after a group of antelopes and grabs one, the other animals calm down almost instantly. They regroup and start chewing grass and play. Animals run away from the place of accident. They have the ability to “forget” about tragedy within few minutes and then go back to the normal life. In contrast, humans run toward an accident, get fascinated by the bloody scene and can develop PTSD. Humans forgot world wars; not remember genocides and major parts of their own history, but unable to forget small offences and imaginary insults. The latest achievement of human civilization is the efforts and ability to forget heroes of the past and even present. In our currents textbooks majority of medical discoveries are mostly nameless as if we do not want to remember pioneers who discovered secrets of human’s disorders. Our education now is about information but not about who and how our teachers taught humans be humans.

This story I heard long ago from professor Samuel Mnuchin when I was a medical student in Leningrad (now St. Petersburg), Russia. Dr. Mnuchin was a pupil of a famous neurologist Vladimir Bechterev, who discovered the nature of spinal stenosis (orthopedic surgeons forget that it was previously called “ Bechterev’s disease”). Prof. Mnuchin must be included in the “Red Book” in the extinct tribe of “super sapiens” – the fascinating breed of the old generations of physicians – encyclopaedists, wise mentors, who naturally and warmly took on the role of the father’s figures for the fatherless generation during the Stalin’s butchered years. After formal lectures and clinical rounds we were continue listening to his amazing stories from the history of medicine about experiments by physicians on themselves, about discoveries, achievements and failures, about grateful and ungrateful patients. He openly talked about weaknesses of our medicine and about the great doctors of the Past who devoted their life to Her Majesty Medicine.

Professor Mnuchin did not only fill us with knowledge. He lit sparkles in our eyes and ignited fire in our hearts. He made us romantics of medicine who prepared to be ready to endure for any difficulties in a complicated life of a Physician. “Physician – is not a specialty” – he used to say. – “Phisician – is your destiny”. He tried to seduce us to psychiatry. “The goal of medicine – is to save a life. The aim of psychiatry – is to save a Person.” He especially cautioned us against cynical attitude, arrogance and conceit. He taught us professional modesty.

During one of these teaching rounds, when we daydreamed about omnipotent abilities of future medicine that would cure any disorder at 100% someone asked the professor to tell us about a case when he was 100% sure he and only he saved the life of the patient. Uponreflection, Mnuchin said: “ You know, when I was a student of Vladimir Bechterev he told our group the story about 100% saving life by doctor Sergey Botkin, the doctor who discovered the nature and treatment of hepatitis ‘A’ which used to be known as “Botkin’s disease”. This is his story… We all became quiet and prepared writing details of the magical cure.

– “ At that time Botkin himself felt sick and made a trip to the Caucasus Mountains to heal himself.” – Mnuchin started his story by closing his eyes as if he moved in his memory to the time in far past when famous people got off their bronze and granite pedestals and were ordinary people with ordinary strengths and weaknesses.

Human memory of time has some secret magic. If we had boring or difficult time – we remember that the day lasted too long, week was going faster, and years were flying by. This effect is known to all. But the fact that centuries are compressed in the memory of a couple of generations I somehow did not realize. Our teacher, not a very old man, was telling as about his personal meetings with Bechterev and Botkin’s who lived almost two centuries ago as his close friends while we only saw the portraits of these celebrities in the yellowish books and on the old greenish sculptures. As for us it seemed “prehistoric”, as if these people came back from the antique times like of Hippocratis or Napoleon. But here we were- sitting in a class and listening the alive teacher’s personal recollections about people from the long past. I myself remember as the most celebrated telepath, genius of the 20th Century, Volf Messing, at the dinner table shared with my family about his meetings with Freud and Einstein. One legend talks casually about another legends as if there are still among us.

Mean time Mnuchin continued telling his story as if he dictated a medical case. – The Caucasus at that time was a place of physical and spiritual retreat, exceptional hospitality and deep honor to foreigners. One evening emotionally exited local shepherd knocked on the door of the house where Botkin was staying. He cried that over there, on the top of a hill his wife is dying. She is heavily breathing, loudly moaning, and can’t talk. Her eyes are rolling up and foam was coming from her mouth.

We started writing feverishly: “OK, so far it is clear – most probably pneumonia with a toxic syndrome. And where is the diagnostic secret is hidden here?” Looking into the window, Mnuchin continued quietly. – Despite feeling bad, Botkin took his bag with medications and followed after the shepherd up to the top of the hill. He had problem walking and breathing and took frequent stops. Near the shepherd’s house someone was sharpening a big knife. On the Botkin’s question the shepherd explained that when someone is dying – there is local tradition to kill a sheep to roll the dying person into the sheep’s skin and vital energy of the sheep will reanimate the dead.

When Botkin finally reached the shepherd’s house and saw his wife. She was frequently losing consciousness and looked like she is almost dead. Diagnosis – severe pneumonia. The doctor gave her his medications, wrapped her in wet sheets. In the morning the temperature fell to normal and the woman felt better.

We exhaled with the great disappointment. So what! What’s big deal! We got diagnosis instantly from the start! The patient might have a night crisis from medications and even spontaneously which is very common. Although, at that time he did not know about penicillin, but what is the secret? And, what is the point of the story?

Mnuchin looked around, waited while the group quieted down and said. – Yes! In my time our group reacted to the Botkin’s story exactly the same way as you do now. Do you know what Botkin said to his students? The world renowned doctor Botkin who saved the thousands of lives said: “Dear Colleagues! I declare with all responsibility that this was the one and only the case in all my 40 years of clinical practice, when I am 100% sure that I and only I really saved the life… of that sheep”.

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